Advancing Medicine Through Evidence-Based Research Medical – Clinical – Research (ISSN 3069-9088) is an international, peer-reviewed open access journal dedicated to advancing knowledge across all areas of medicine. The journal publishes high-quality original research, clinical studies, reviews, and case reports that enhance the understanding and improvement of healthcare practices. With a strong focus on innovation, evidence-based practice, and interdisciplinary collaboration, the journal provides a platform for researchers, clinicians, and healthcare professionals to share findings that influence patient care and medical science globally. Key topics covered include, but are not limited to: Internal medicine and primary care Surgical techniques and innovations Infectious diseases and immunology Cardiovascular and respiratory medicine Neurology and psychiatry Oncology and hematology Pediatrics and geriatrics Reproductive and maternal health Clinical pharmacology and therapeutics Translational and evidence-based medicine
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Vitiligo is an autoimmune skin disease, affecting 0.5% of the world population. It is quite invalidating psychologically, because of the appearance of visible white zones of depigmentation, especially when situated on the face, neck, arms, etc. It is associated with melanocyte destruction; the cells producing and storing melanin pigment. It is actually known to be a CD8T cell-mediated autoimmune disease, involving innate immune cells, keratinocytes and fibroblasts. The melanin produced defines hair and skin color. Once it has come to maturation, it is transferred to keratinocytes via dendritic expansions of the melanocyte by phagocytosis. Once in the keratinocyte, it forms a supranuclear cap and protects us against UV irradiation. A tenfold of patients with segmental type of vitiligo have been treated successfully with LED red light, for at least sixteen weeks, one session a week. Evaluation of melanin concentration was effectuated with a 3D Antera camera. Almost all patients showed partial, if not complete, recovery and repigmentation of the deserted areas. Parameters of treatment sessions will be indicated. Red light (630 nm) also has the capacity to stimulate the melanocyte-hair unit and repigment white hair. A brief comparison of the melanocyte-skin and the melanocyte-hair follicle unit will be discussed. Trying to understand the effect of red light on these cells and the mechanisms of action, including melanocyte migration and melanin production, are very important for developing new treatment options in this field. LED red light is safe, painless, and offers a satisfactory treatment option for vitiligo. Studies of a larger scale should be performed.
Copyright (c) 2026 Medical - Clinical - Research https://creativecommons.org/licenses/by/4.0
Neonatal Hypoglycemia: A Diagnostic and Therapeutic Emergency - Current Status and a Clinical Case Report
Background: Neonatal hypoglycemia is a common metabolic condition associated with a risk of significant neurological morbidity. Its definition remains controversial due to the lack of a universally accepted glycemic threshold. Transient forms related to perinatal stress are increasingly recognized but may present with severe and recurrent episodes. Case Observation: We report the case of a term newborn presenting with early-onset recurrent hypoglycemia. The perinatal period was marked by moderate asphyxia, hypothermia, and secondary neonatal sepsis due to Escherichia coli. Despite early nutritional management, severe hypoglycemia (0.16 mmol/L) occurred within the first 24 hours of life. Biological evaluation revealed inappropriate hyperinsulinemia associated with hypoglycemia, elevated growth hormone levels, and transiently low cortisol with a normal Synacthen response. The diagnosis of transient hyperinsulinism in the context of perinatal stress was retained. Glycemic control was achieved through optimized glucose intake without the need for specific pharmacological treatment. Discussion: This case highlights the multifactorial nature of neonatal hypoglycemia and the central role of transient hyperinsulinism in stress conditions such as perinatal asphyxia and infection. The absence of neurological symptoms despite severe hypoglycemia raises questions about individual cerebral tolerance and compensatory metabolic mechanisms. However, the risk of delayed neurodevelopmental impairment remains significant. Conclusion: Neonatal hypoglycemia requires early recognition, prompt management, and thorough etiological investigation. Transient hyperinsulinism should be considered in cases of persistent or recurrent hypoglycemia, particularly in the context of perinatal stress. Long-term neurological follow-up is essential.
Observation of a Case of Roberts Syndrome in the Tabacoto Gold Zone, Bamako, Mali, July 2025
RBS syndrome has rarely been reported in the African population. A previous study [4] reported a case of Roberts syndrome with tetraphocomelia. We report here the first case of Roberts syndrome in a tabakoto gold zone in Mali with cleft lip, amelia of the lower limbs, and absence of genital organs and anal canal. The patient was a newborn with severe polymalformation: cleft lip, complete agenesis of both lower limbs, absence of external genitalia and anal canal. The diagnosis is based on clinical examination, supplemented by imaging, with cytogenetics playing an essential role in identifying the aetiology. Treatment, which is mainly palliative, includes psychological support for the mother from the postnatal phase onwards. The prognosis remains poor, particularly in clinically severe forms.
Jupyter Notebook and JupyterLab have become widely adopted platforms for interactive data analysis, teaching, and reproducible research. While many polyglot kernels enable multi-language execution through in-notebook language switching and in-memory data exchange; such approaches often blur language boundaries, resulting in increased coupling to kernel-specific abstractions, and complicate reproducibility outside the notebook environment. We present the SiPy kernel, a lightweight Jupyter kernel designed not as a multi-language interpreter but as a coordination interface for script-based scientific workflows. SiPy treats R, Julia, Python, and shell scripts as first-class external artefacts, executing them as standalone scripts rather than embedded notebook fragments. This design preserves explicit execution boundaries, enhances portability, and ensures that analytical components remain runnable outside Jupyter. The kernel integrates the SiPy interactive shell into Jupyter while maintaining minimal dependence on internal notebook APIs and avoiding interpreter embedding. Features include controlled execution with configurable timeouts, structured output capture, and support for HTML rendering within cells. By positioning Jupyter as a narrative and documentation layer rather than a computational substrate, the SiPy kernel offers an alternative architectural model for polyglot scientific computing that prioritizes transparency, reproducibility, and long-term maintainability over convenience-driven abstraction.
Systematic Review of Gamification in Medical Teaching and Learning
This systematic review inquiries into the use of gamification in medical teaching and learning and has focused on which game‐design principles support the best the cognitive, affective, and psychomotor learning results. A total of 58 empirical studies met inclusion criteria based on a thorough search in six databases (i.e., PubMed, Scopus, Web of Science, ERIC, CINAHL, Cochrane Library). Data was then mapped onto existing taxonomies of game mechanics (points, badges, leaderboards, narratives and feedback loops) and design principles (personalization, challenge and progression). Levels of learning indicators were classified by Bloom’s and SOLO taxonomies. Significance Applied interventions combining these two tradition elements of gamification (context and challenge) were more supportive of knowledge transfer, clinical reasoning, and enhanced motivation. Yet, at times competition-oriented mechanisms created stress and compromised cooperation. The theoretical grounding of very few (12%) studies was methodologically convincing, highlighting that stronger ties to educational theory are warranted. Key barriers were technology, lack of faculty development, and data privacy. Ethical issues focused on informed consent for data gathering, and hazards of behavioral modification. In general, gamification holds potential for enhancing medical curricula, but its design needs to be theory‐informed and ethically sound with consideration of diversity of learners. In future research studies, researchers are encouraged to use longitudinal research designs, establish common measures for their outcomes, and investigate mechanisms that are less studied like storytelling or social interaction.
Acral Amelanotic Melanoma: A Literature Review and Report of Four Cases
We present four clinical cases of patients with dark skin, Fitzpatrick phototype 4, with amelanotic acral melanoma. Three were women and one was a man, who had a fatal outcome. We provide a brief literature review, including the pathophysiology of amelanotic melanoma, emphasizing clinical, dermatoscopic, and histological characteristics to avoid delays in diagnosis.
Immunotherapy with Natural Killer Cells: Are Intact Cells Required, or Can Their Bio-Lysate Achieve Therapeutic Efficacy?
Infusion of engineered immune cells has shown some therapeutic efficacy in cancer patients but high costs and in some cases more significant side effects are supporting the need for new approaches. Here we present a perspective on cellular bio-lysate from NK-92 cells. These cells rapidly proliferate and a method to extract their cytotoxic bio-lysate for clinical application has been developed. The bio-lysate has cross- species anti-tumor activity and also provides a durable, vaccine-like effect.
When Neurofibromatosis Type Is Mistaken for a Curse in Our Society: A Case Report
Neurofibromatosis type 1 (NF1), or Von Recklinghausen’s disease, is a tumor predisposition syndrome and one of the most common genetic disorders. It affects approximately one in 3,000 births, has a penetrance close to 100%, and 50% of new cases result from de novo mutations (located on chromosome 17 at 17q11.2). We report the case of a 22-year-old female student who presented to the Dermatology Department of the University Clinics of Kinshasa with tumorous masses that had developed since the age of four. The condition began with light-colored patches on the body, followed three years later by asymptomatic solid lesions on the back and face that progressively increased in size and number, prompting consultation. Several treatments had been attempted without improvement, and the patient had also sought traditional medicine. A diagnosis of neurofibromatosis type 1 was established. Surgical excision of the plexiform tumor was proposed, but the patient declined. A biannual follow-up was scheduled. Neurofibromatosis type 1 remains poorly understood in our society and continues to be a major cause of stigmatization, particularly when the lesions are visible.
Prevalence Effectiveness and CT Presentations of Coronary Artery Disease amongst Adults Undergoing Coronary Artery Calcium Score at PBS Yaounde
Background: Coronary artery disease (CAD) is one of the major cardiovascular diseases affecting the global human population. This disease has been proven to be the major cause of death in both the developed and developing countries. The prevalence of CAD increases mortality, morbidity, and impairs patient quality of life. Despite the widely established CAD risk factor burden in SSA, there is still a paucity of data on its epidemiology in Cameroon. Thus the purpose of this study. Objective: To assess the prevalence effectiveness and CT presentations of coronary artery disease amongst adults undergoing coronary artery calcium score at Centre Medical «les Promoteurs de la Bonne Santé Yaoundé». Materials and Method: This was an analytical cross-sectional study, carried on 80 adult participants undergoing coronary artery calcium score, which was calculated using the Cochran formula and a convenience sampling method. A structured form was used to collect data, saved in USB key and later analysed using SPSS version 27.0. This study included participants who gave their consent. An ethical clearance was obtained and an authorization obtained from the delegation of public health and from the director of centre medicale les promoteurs de la bonne santé. Participants’ informations were kept private to maintain confidentiality. Results: They were 60 participants. 53.3% were female, 33.3% of participants were aged ≥70yrs. The prevalence of CAD was 80%. The relationship between age and was statistically significant p=0.000. Hypertension and low HDL were the dominant risk factors accounting for 58.3% respectively. 43.30% of participants were classified as very low risk according FRS. While 46.70% were classified as low risk using CACS. Agreement between the FRS and the CCS was found in 35 patients (58.3%). Hence there is a statistical significance between FRS and CACS (P value<0.001). Conclusion: Findings from this study support the prognostic value of coronary artery calcium score and its use as a screening test for coronary artery disease. Therefore, proper implementation should be done to improve early diagnosis there by reducing the prevalence of coronary artery disease.
Evaluation of the Scaling up of the Integration of Postpartum Family Planning Services with Maternal, Newborn, Infant, and Nutrition Services (PFPP/MNNI-Nut) in Health Districts in the Kayes Region, Mali
In Mali, the maternal mortality ratio is 325 maternal deaths per 100,000 live births. In response to this situation, seven health districts in the Kayes region have begun implementing a plan to scale up the integration of postpartum family planning services with maternal, newborn, infant, and nutrition services (PFPP/SMNI-Nut). The objective was to evaluate the implementation of the integration of PFPP/SRMNI/Nut services in seven health districts in the Kayes region, in order to describe the process, results, lessons learned, and challenges encountered with a view to facilitating national scaling up. Methodology: This was a mixed-method study supported by documentary analysis, covering the health districts of Kayes, Nioro, Diema, Bafoulabe, Sefeto, Sagabari, and Kita (Kayes region). Results: A total of thirty (30) trainers trained 157 Center Technical Directors (CTDs) out of 205 (76.58%), 205 maternity ward managers (100%), and thirty-eight (38) mentors. In terms of outcome indicators, the rate of PFPP use among women who had given birth was highest in Diéma at 72% and lowest in Sagabari at 35%. The districts of Bafoulabé (68%), Kita (67%), Nioro (63.9%), and Kayes (59%) recorded more PFPP users in postnatal consultations (CPoN). The district of Nioro recorded the highest rate of PFPP users in preventive child health monitoring (SPE)/vaccination, at 86.73%. The level of satisfaction among beneficiaries with prenatal consultations (CPN) was satisfactory in 81.4% of cases for the provision of integrated services, while 18.5% were dissatisfied with waiting times and 75.9% considered the cost to be satisfactory. Training, reorganization of patient flows, and mentoring are key factors in the implementation of service integration. Conclusion: Strengthening mentoring, close supervision, and implementation of the advocacy plan appear to be key levers for ensuring the sustainability and effectiveness of scaling up.
Trauma-Informed Care in Nursing Education: Psychological Safety, Compassion Fatigue, and a Watson-Guided Framework for Healing-Centered Learning
Trauma-informed care (TIC) has become a foundational expectation in clinical nursing practice; however, its systematic integration into nursing education remains inconsistent. Nursing students and practicing nurses engaged in educational programs frequently enter learning environments with prior trauma histories while simultaneously encountering new stressors through high-stakes evaluation, exposure to human suffering, workplace incivility, and moral distress. When educational climates rely on fear-based rigor or public correction, psychological safety is compromised, increasing risk for disengagement, compassion fatigue, burnout, and attrition. This manuscript presents an integrated examination of trauma-informed nursing education, emphasizing psychological safety as a prerequisite for learning, compassion fatigue and burnout as early-onset professional risks, and Jean Watson’s Theory of Human Caring as a discipline-rooted framework to counter trauma within educational spaces. Guidance from the American Nurses Association, American Nurses Credentialing Center, and National League for Nursing is synthesized to demonstrate that trauma-informed, psychologically safe education is an ethical, safety, and workforce imperative.
Spinal Disorders in Children and Adults: Biomechanical Aetiology of So-Called Idiopathic Scoliosis (1995–2007), New Classification. Therapeutic Implications for Back Pain Syndrome
The authors present the ethology of So-Called Idiopathic Scoliosis. The discovery of its aetiology was between 1984/1995 – 2007 (T. Karski). The spinal curvature deformity is connected with biomechanical influences—the permanent habit of standing ‘at ease’ on the right lower limb in two groups and with specific patterns of walking, also in two groups in the new Lublin classification. The classification (described between 2001 and 2004) contains three (3) groups and four (4) types of scoliosis. This article presents new therapy and rules of causal prophylaxis for these spine disorders. In the second part of the article, a “new point of view” on adult back pain syndrome and methods of therapy is presented. The causes of back pain syndromes are described – mostly uncured or incorrectly cured scoliosis and hyperlordosis of the lumbar spine. Methods of physiotherapy are also presented and described.
Evaluation of the Use of Non-invasive Neurophysiological Indices in the Prediction of Outcome in Patients with Severe TBI
Aim: To evaluate the usefulness of noninvasive clinical neurophysiological indices as predictors of clinical outcome in patients with severe head trauma treated at the Bajío T1 High Specialty Medical Unit in León, Guanajuato. Material and Methods: An observational, analytical, retrospective and cross- sectional study will be carried out, based on the review of clinical records of adult patients diagnosed with severe head trauma, treated in the emergency department of UMAE HES No. 1, National Medical Center of Bajío, in the period between July 2023 and April 2025. This institution corresponds to a third-level hospital that has specialized areas for the care of neurocritical patients, advanced technology and personnel trained in emergency medicine. Results: During the observation period, 65 patients diagnosed with severe traumatic brain injury (TBI) treated at the UMAE Specialty Hospital No. 1 of the National Medical Center of Bajío were analyzed. The average age was 45.4 ± 15.0 years, with a median of 44 years (range: 17–85). The age distribution showed a predominance in the group of young and middle-aged adults, corresponding to the characteristic epidemiological profile of severe TBI. Upon admission to the emergency department, patients presented an average total score on the Glasgow Coma Scale (GCS) of 5.5 ± 1.8 points, with a median of 5 (range: 3–10), reflecting severe neurological involvement in most of them cases. This value is within the threshold that defines severe head trauma and is consistent with trends described in international studies, where the majority of patients with severe TBI present with a GCS score less than 8. The FOUR Scale showed a mean of 6.7 ± 2.3 points and a median of 7, parameters that show clinical correlation with the level of neurological deterioration measured by the GCS, providing complementary information on brainstem function and respiratory pattern. Conclusion: The present study demonstrated that noninvasive neurophysiological indices—including the Glasgow Coma Scale (GCS), pupillary reactivity, brainstem reflexes, respiratory pattern, and sedation—are useful clinical tools and predictors of functional outcome and mortality in patients with severe traumatic brain injury (TBI), even in the absence of invasive monitoring.
The Role of Genetic Mutations in SETD2 Gene on the Luscan-Lumish Syndrome (LLS)
Luscan et al. described two unrelated individuals with similar clinical features including postnatal hypertrophy, macrocephaly, obesity, speech delay, and advanced wrist ossification. The patients also had long, large hands and feet. Facial features included a prominent forehead with a high forehead hairline, downward sloping palpebral fissures, a long nose, a long face, hypoplastic cheeks, and a prominent lower jaw. CT scan in one patient showed mild ventricular dilatation; brain MRI in this patient revealed nodular and punctate hyperfast signals in the anterior parts of the radial cortices and in the central semi-ellipses.
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Fusiform Gyrus: The Sorcerer of the Brain and Architect of Subjective Reality
The Fusiform Gyrus is the sorcerer of the brain, defining it according to the dictionary of the Royal Academy, as one that bewitches or awakens strong attraction, allowing facial recognition, visual memory, color perception, visual processing of words or the identification of objects and shapes. It is where reality is constructed, the place where hallucinations and schizophrenia and some other mental disorders lie. It is also where the spell of physical and mental affinity is built, connecting the different parts of the brain with the occipital lobe, passing through the temporal lobe, it is where the visual pathway runs to the angular gyrus to give color to objects and words. In his performance, he visits the cerebral amygdala for the recognition of facial emotions and takes over with Brodmann's areas 22, 36, 37, 39 and 40; to give meaning to the words heard, to recover autobiographical memories, to understand metaphors and signs, to understand verbal and written language and to link graphemes and phonemes for reading and writing respectively. For all these wonderful functions, we consider the Fusiform Gyrus to be the mental sorcerer that constructs emotions and subjective experience.
The Sweeping Reach of COVID 19: from Public health Emergencies and Psychological Turbulence to Upheaval and Environmental Transformation
The COVID‑19 pandemic has upended the course of health, economies, mental well‑being and even the planet’s ecological balance. As a public‑health emergency it strained hospitals to the breaking point laid bare deep‑seated inequities and exposed gaps in our crisis preparedness. At the time it sparked a wave of psychological strain across societies with spikes in anxiety, depression, trauma and loneliness especially among frontline clinicians, disadvantaged groups and younger generations. Economically the pandemic’s shockwaves ripped through markets sent supply chains into chaos and turbo‑charged job loss and financial insecurity with informal and service‑sector workers feeling the squeeze most acutely. The skewed funneling of resources and the patchwork nature of recovery schemes only deepened pre‑existing rifts prompting a clamorous push for reforms that are genuinely inclusive and equitable. In the arena the brief lull of lockdowns did give a momentary breath of fresher air and cleaner water, but those fleeting wins were quickly swamped by a surge of biomedical waste, an upswing, in plastic usage and a softening of regulatory oversight. This paper delves into the many‑sided fallout of the COVID‑19 crisis through a perspective that pulls together public health, psychology, economics and environmental science. It treats the pandemic as a sort of stress test for systems exposing how fragile they can be and flagging the urgent need for enduring policy overhaul. Throughout the analysis highlights the importance of coordinated governance equitable access, to medical care the embedding of mental‑health services economic models built for resilience and vigilant stewardship of the environment. By weaving fresh data and policy analysis this study deepens the overall understanding of post‑pandemic recovery and resilience. It proposes recommendations for building systems that're more adaptable, inclusive and interconnected so they can better endure future global health threats. The article also includes visual data displays to help clarify the overlapping impacts of the pandemic.
Association of Serum Uric Acid Levels and Atheromatosis of CarotidArteries in Hypertensive Patients
Introduction: The atherogenic and inflammatory effect of the serum uric acid, is evident, as well as its role and its significance in the process of the carotid atherosclerotic disease. Objective of the study: The aim of this study is to investigate a possible association between the serum uric acid levels and fibrinogen with the atheromatosis of the carotid arteries of hypertensive patients Research Design and Methods: We studied 1296 hypertensive patients (54.8% female), treated or newly diagnosed untreated, of median age: 61 (51-69) years, without any known cardiovascular disease and with mean office systolic/diastolic arterial blood pressure (S/DBPo): 145.5±19.55/89.8±12.5 mmHg, mean office heart rate (HRo): 74.4±9.9 bpm, median body mass index (BMI): 27.5 (25-30) kg/m2 and median waist circumference (WC) 96.1(87-104) cm. The levels of serum uric acid (SUA), fibrinogen (in a subgroup N= 628), urea and creatinin, were recorded and eGFR was calculated according MDRD formula Equation. All patients underwent acarotid ultrasound test. Intima-media thickness was measured (IMT) and the presence of atheromatus plaque was also investigated. The study population was separated in two groups, according the IMT value and the existence or not of atheromatous plaque Group A: IMT≥0.9mm or/and existence of atheromatous plaque (72,1%) Group Β: IMT<0.9mm and without any atheromatous plaque (27,9%) (t-test between the two groups p<0.001). By using the ANOVA statistic method, we registered the SUA and fibrinogen level values in both groups. By using Pearson correlation, we correlated the SUA levels with serum fibrinogen levels. Results: Significantly more patients in the total study population had carotid atheromatous plaques (72,1% vs 27,9% p<0.001) without any statistically significant differences in the prevalence of atheromatous plaques between male and female Pearson chi –Square NS (0,274). There were significantly higher levels of SUA in Group A Vs Group B (5,4±1,6 vs 5,0±1,6mg/dl p=0.001) as also between the male and female population (SUA men: 5,9±1,5 vs 5,8±1,4 by groups NS, women: 4,9±1,6 vs 4,3±1,4 p <0.001). As far as the fibrinogen levels are concerned, there were significantly higher levels in group A vs group B (361,6±99,7vs 332,7±84,6 mg/dl p=0.001), in the sex-specific association of fibrinogen and increased carotid intima-media thickness or the existence of carotid plaque (fibrinogen men: 341,5±91,4 vs 321,7±77,5 by groups NS, women: fibrinogen 377,3±103,2 vs 341,7±89,3 p =0.002), the significance remained only in women. There was also a significant correlation between SUA and fibrinogen (r=0.206, p<0,001), a significant regression between SUA and fibrinogen (p<0,001), while more patients were treated (with antihypertensive treatment) in Group A (65,6 vs 42.8 % p=<0.001). In Group A, also, the patients had significantly lower DBPo (88,6±12,4 vs 92,9±12,4mm Hg p<0,001) and significantly higher PPo(56,5±15,3 vs 53,7±14,7 mmHg p= 0,003). The age and the eGFR of Group A vs Group B patients were significantly different:63,4±10,9 vs 52,0±12,9 years p<0,001 and 74.6±34.6 vs 86.2±39.9mL/min/1.73m²p<0,001 respectively. Conclusion: In hypertensive patients treated or not, with high proportion of carotid atheromatosis, the existence of increased thickness or atheromatous plaques in carotids, was associated with significantly higher SUA and fibrinogen levels, in women, in a more severe burden of atherosclerosis patients, possibly indicating their importance in the atheromatous status of hypertensive patients, while a significant positive correlation exists between SUA and fibrinogen levels in this population.
Treatment of Le-fort 1 Fractures Done at Tertiary Center within 2 years’ Time Duration from January 2022 to December 2025
Study Design: A retrospective study. Objective: This study mostly focuses on addressing malocclusion related to the fractures and outcome after doing open reduction and internal fixation. Methods: Our retrospective study included 43 patients diagnosed with unilateral and bilateral Le-fort fractures who went open reduction and internal fixation. Demographic data, causes of trauma, accompanying facial bone fractures, treatment methods, and complications were analyzed. Fisher’s exact test was employed to assess the association between fractures and malocclusion. Results: During follow up days 10 patients complains of sensory, 4 patients complain of derranged occlusion, 3 patients complain of facial deformation and 2 patients complains of sensitivity of teeth. Condylar fractures showed a statistically significant association with occlusal disorders (P = 0.044). Surgeon variability did not significantly impact occlusal outcomes (P = 0.25). Conclusions: Management of facial bones requires a thorough understanding of surgical principles, anatomy, occlusions and consideration of concomitant fractures. Fracture reduction is gained based on occlusion is crucial for successful outcomes, and in some old cases additional Le Fort I osteotomy may be considered. Occlusion is key factor in management of any facial bones, mostly mandibular and maxillary factures.
Arts-Based Supervision & Empathic Creativity: Epistemology and Ethics
This article considers the supervision in arts therapies in an epistemic and ethical perspective as well as for its clinical implications. Historically supervision is defined as an attribute of psychiatrists, psychoanalysts, psychologists or psychotherapists. Ability to transfer/countertransfer analysis and/or pathology aknowledgements might appear as fullfilling criteria for a qualified supervision in arts therapies. But, if we believe that arts therapies involve deep understanding of the creative process in the context of a specific therapeutic relationship, then the supervisor has to be trained in the phenomenological and intuitive approaches of the art/creative praxis and of the empathic creativity. Exclusively verbal communication in supervision limits the creative resonance and empathy as it is focused on logical/analytical thinking. Using response art offers the opportunity of a deeper atunement in the client/arts therapist/supervisor’s triangle. Viewing client’s production, sharing art therapist’s response art and involving the supervisor’s own creative resonance fosters a multilayers intuitive knowledge. This is corresponding to the unconcious emotional dynamics at work in arts therapies. In this perspective, considering the use of arts-based supervision is an epistemic necessity as well as an ethical issue. It offers responses both to the epistemic paradoxe and to the ethical dilemma of verbalizing on non-verbal phenomena. The arts-based supervision is focused on the arts therapies’ core - and thus able to offer pertinent help both to the client’s clinical needs and to the supervisee’s professional growing. A few clinical examples illustrate these reflections.
COVID-19 Infection Relative Risk Reduction versus Absolute Risk Reduction Since 2023 to 2024 in a General Medicine Office in Toledo (Spain)
Background: The expression of the true impact of COVID-19 prevention measures in daily practice on the population (public health measures, vaccination, natural immunity) can be confusing when presented as relative risk reduction (RRR) or absolute risk reduction (ARR). Objective: To compare the RRR with ARR of SARS-CoV-2 infections, associated with acquired immunity by vaccination and/or infection since 2023 to 2024. Methodology: Comparison of secondary data of COVID-19 infection cases in since 2023 to 2024 years of previous studies carried out in the same population of patients treated in a general medicine office in Toledo, Spain. For the calculation of RRR and ARR of SARS-CoV-2 infections, cases in 2023 were considered as control group with respect to cases in 2024. Results: For the total number of COVID-19 cases (>=14 years) from 2023 to 2024 [In 2023-2024 omicron subvariants were dominant; Fourth dose (second booster) was inoculated in fall-winter 2022-2023; Fifth dose (third booster) was administered in fall-winter 2023-2024]]: an RRR of 25% and an ARR of 1% were found. For all the selected variables studied, the ARRs were always much lower, somewhat lower, or occasionally equal to the RRR. Conclusion: Expressing the reduction in the risk of COVID-19 as RRR when comparing incidence rates in 2024 versus 2023 shows an exceptionally striking appearance of risk reduction that is not present in its expression as ARR. Presenting results in terms of both ARR and RRR is more comprehensive, allowing both an estimation of the intrinsic preventive efficacy of hybrid immunity and its efficacy during translation to the real world.
Mapping Changes in Executive Functioning, Emotion Regulation and Wellbeing Indicators During COVID-19 Second Wave in India: Investigating Psychological Effectiveness of a Short-Online, Advanced Yoga and Meditation Program
The present study sought to examine the changes in executive functioning, emotion regulation, and other positive psychological outcomes among participants following their completion of a four-day online advanced yoga and meditation program conducted during the COVID-19 pandemic. The study included 32 participants (11 men and 21 women; Mage = 38.12 years; SD = 9.65) who completed the standardized Stroop test and Go/No-go task for executive functioning assessment. Participants also responded to Emotion Regulation Questionnaire and Cognitive Emotion Regulation Questionnaire- Short Version, Multidimensional Flourishing Scale, Peace of Mind Scale, and Harmony in Life Scale through the Android smartphone app, PsyEx, in a pre–post-test design. The results of pre–post test scores using paired t-test on Stroop task showed statistically significant improvement for inhibitory control or response inhibition, cognitive flexibility, and selective attention from the online advanced yoga and meditation program. The results also revealed that the participants made significantly greater use of cognitive reappraisal strategy for emotion regulation and reported significantly lower use of expressive suppression emotion regulation strategy after the advanced yoga and meditation program. The study findings also revealed a significant improvement in overall flourishing, harmony in life, and peace of mind among participants following the short, intensive online advanced yoga and meditation program. The present study demonstrates the effectiveness of short, online yoga- and meditation-based programs in improving emotional regulation, executive functioning, and overall well-being. Furthermore, the study provides robust evidence supporting the integration of yoga- and meditation-based programs as effective psychological interventions for diverse populations.
Adherence of Patients with Varicose Veins to Compression Therapy
Objective. To determine adherence to the implementation of medical recommendations regarding compression therapy within 1 year after receiving them by patients with varicose veins of the lower extremities. Material and methods. A prospective comparative study Patients cOMmitment to coMpression theraPy (POMP) was conducted with the participation of phlebologist surgeons, each of whom included patients with varicose veins of the lower extremities in the study for 5 weeks, who sought consultation and needed compression therapy. Twelve months after the consultation, an outsourced call center conducted a telephone survey of patients in order to obtain information on the specifics of their compliance with the recommendations received. Results. The general registration database of the study contained individual data on 394 patients. 12 months after receiving recommendations on the use of compression hosiery, 246 patients aged 44, 35-55 (Me, IQR) were available for a telephone survey and agreed to complete it. There were 42 men (17.1%), 204 women (82.9%). Among them, class C1 was noted in 32 (13.1%), C2 in 83 (33.7%), C3 in 109 (44.3%), C4 in 20 (8.1%), C6 in 2 (0.8%) patients. 189 patients (76.8%) were compliant with medical recommendations: 110 using compression hosiery and 79 who stopped taking it based on medical recommendations. The number of respondents who noted an improvement in the manifestations of varicose disease was significantly higher in the group of patients who used compression hosiery (p < 0.001). Patients who already had experience with compression therapy (p < 0.001) and patients whose professional activities are associated with heavy physical labor and long-term orthostasis (p = 0.031) were more committed to compression therapy. There were no reliable differences in patient compliance with differences in gender and education level. Conclusion. High patient adherence to medical recommendations regarding compression therapy was established 12 months after receiving them.
Non-Surgical Management of Acute Appendicitis in the Presence of West Nile Encephalitis
This case report describes the complex management of a 62-year-old immunocompromised male presenting with acute appendicitis and concurrent West Nile virus (WNV) meningoencephalitis. Initially treated conservatively with antibiotics for appendicitis, the patient's condition deteriorated due to neuroinvasive WNV, complicating clinical assessment and decision-making. Imaging confirmed acute appendicitis without progression, and antibiotic therapy was continued successfully despite impaired consciousness. This case highlights the challenges of managing intra-abdominal infections in patients with concurrent central nervous system involvement, emphasizing the need for multidisciplinary collaboration and the potential viability of non-surgical appendicitis treatment in select high-risk cases.
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Metabolic Syndrome And Jak Inibitors: Current Status And Perspective
Obesity is a major risk factor for metabolic syndrome (MetS), a cluster of metabolic disorders including hepatic steatosis, hyperglycemia, hyperlipidemia, and hyperinsulinemia. Chronic low-grade inflammation (CLGI), particularly in adipose and hepatic tissues, plays a key role in the onset of MetS, with Toll-like receptors (TLRs) and cytokine signaling pathways such as NF-κB activation being central mediators. Recent studies highlight the involvement of the gastrointestinal (GI) tract and mucosal immunity, particularly the role of Janus kinase 3 (Jak3), in regulating gut inflammation and barrier functions. Loss of Jak3 expression in the colonic mucosa is associated with increased susceptibility to obesity and CLGI, suggesting a potential role in the pathogenesis of MetS and related diabetes. However, the specific mechanisms by which Jak3 contributes to these processes remain to be fully elucidated.